Mycoplasma infections involve pulmonary and various extrapulmonary organs, but the importance to each organ of direct invasion and cytotoxicity has not yet been determined. Immune responses to Mycoplasma pneumoniae infection result in the production of a large number of autoantibodies against lung, liver, erythrocytes, heart, and brain, 1 possibly due to crossreactivity between M. pneumoniae and human tissue antigens. 2 Production of these autoantibodies may well be responsible for the manifestations of mycoplasma infection. Central nervous system (CNS) complications such as meningoencephalitis, transverse myelitis, Guillain-Barré syndrome (GBS), and psychosis can occur in patients with M. pneumoniae infection. 3 The antibody against galactocerebroside (Gal-C), a major glycolipid antigen in the myelin, has been identified in sera from patients with GBS 2 and leukoencephalitis, 4 and may participate in the demyelination process in these cases. Although immune reactions may thus have a crucial role in the pathogenesis of brain involvement, the efficacy of steroid treatment in mycoplasma encephalitis remains controversial.We describe here two patients with presumed post-infectious insults in the CNS, for which immune-mediated pathology was assumed. We emphasize the relapsing and self-limiting nature of the clinical course, and the significance of hypoperfusion on neuroimaging for the diagnosis of this condition. Case reports Patient 1A 9-year-old boy suffered from febrile illness with cough for several days. The fever resolved after administration of clarithromycin, but re-emerged on the 11th day of illness. The diagnosis of mycoplasma pneumonia was made on day 15, and treatment with azithromycin was commenced. He became afebrile by day 16, but appetite loss and apathy appeared at this time. He also became emotionally labile, and he bit his mother on the hand. Mild disturbance of recent memory was noted. He was admitted to hospital on day 21 of illness, when examination of cerebrospinal fluid (cell count, 2/mm 3 ; protein, 14 mg/dL) and brain computed tomography were normal. Electroencephalography (EEG) showed increased slow waves at bilateral frontal areas (Fig. 1a). With suspicion of mycoplasma encephalitis, he was treated with 0.15 mg/kg dexamethasone for 5 days. Conversation became fluent, and he was discharged with almost complete recovery. Inappropriate crying and apathy, however, developed 1 week after cessation of steroid therapy.The patient experienced visual hallucinations, and at times could not recognize his father. He was referred to Tottori University Hospital at this time (Fig. 2). Upon examination his gait was not disturbed but he preferred to lie down. He responded to questions by nodding or in single words. He could state his name, but could not remember his age. Mild disorientation was noted. Otherwise, neurological examination did not indicate any abnormalities. After admission he remained lying on the bed, and ate food directly with his hands. His white blood cell count was 11 400/mL, and his se...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.